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High-risk donors: extending our criteria in times of organ shortage
Alexander M Bernhardt1, Hermann Reichenspurner
1Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Purpose Of Review:
Increasing waiting lists and declining transplant numbers due to organ shortage are a global problem that needs a multimodal approach to overcome this situation. Extending the criteria for transplantation may be one part of the solution.
Recent Findings:
There are political efforts to increase the donor rate and change the listing criteria and the allocation process. Recently, the cardiac allocation score was introduced enhancing the factor urgency to the allocation process. Marginal donor organs can be accepted using ex-vivo perfusion strategies. Experimental approaches, such as donation after circulatory death and xenotransplantation, need to be further developed to be applied to humans and increase the pool of available transplant organs.
Summary:
Organ shortage needs new approaches to overcome the discrepancy between the number of patients on the wait list and performed heart transplantations, reduce wait list mortality and improve long-term outcomes after transplantation.
Insights
Organ shortage is a global challenge impacting heart transplantation. New strategies, including expanded criteria and innovative techniques like ex-vivo perfusion, are crucial to increase transplants and reduce waitlist mortality.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Organ shortage presents a significant global challenge, leading to increasing waitlists and declining transplant numbers.
- The discrepancy between patients needing transplants and available organs necessitates innovative solutions.
Purpose of the Study:
- To review current and emerging strategies for overcoming organ shortage in heart transplantation.
- To explore the potential of expanded donor criteria and novel organ preservation techniques.
Main Methods:
- Review of political efforts and recent advancements in organ allocation and donor criteria.
- Analysis of ex-vivo perfusion strategies for utilizing marginal donor organs.
- Examination of experimental approaches like donation after circulatory death and xenotransplantation.
Main Results:
- Introduction of a cardiac allocation score prioritizing urgency.
- Successful application of ex-vivo perfusion to accept marginal donor organs.
- Ongoing development of donation after circulatory death and xenotransplantation for increasing organ availability.
Conclusions:
- Addressing organ shortage requires a multimodal approach, including policy changes and technological advancements.
- Expanded donor criteria and innovative organ management are essential to reduce waitlist mortality.
- Further development of experimental strategies is vital to increase the pool of transplantable organs and improve patient outcomes.
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